Melanoma Flashcards
What is melanoma?
Neoplastic disorder produced by malignant transformation of the melanocyte.
Melanocytes are derived from neural crest cells.
Which patients are at greatest risk for melanoma?
White patients with blonde or red hair, fair skin, freckling, and history of blistering sunburns, blue or green eyes, actinic keratosis, M > F
What are the most common sites for melanoma?
- Skin
- Eyes
- Anus
What is the most common site of melanoma in African Americans?
Palms of the hands, soles of the feet (acral lentigenous melanoma)
What characteristics are suggestive of melanoma?
Usually a pigmented lesion with an irregular border, irregular surface, or irregular coloration.
Also: darkening of a pigmented lesion, development of pigmented satellite lesions, irregular margins or surface elevations, notching, recent or rapid enlargement, erosion or ulceration of surface, pruritus
What are the ABCDs of melanoma?
Asymmetry, Border irregularity, Color variation, Diameter (> 6 mm) and Dark
What are the associated risk factor for melanoma?
Severe sunburn before age 18, giant congenital nevi, family history, white, UV radiation, multiple dysplastic nevi
How does location of melanoma differ in men and women?
Men get more lesions on the trunk, women on the extremities
Which locations of melanoma are unusual?
Noncutaneous regions, such as mucous membranes of the vulva or vagina, anorectum, esophagus, and choroidal layer of the eye
What is the most common site of melanoma in men?
Back
What is the most common site of melanoma in women?
Legs
What are the 4 histologic types of melanoma?
- Superficial spreading
- Lentigo maligna
- Acral lentiginous
- Nodular
What is superficial spreading melanoma?
Occurs in both sun-exposed and non-exposed areas.
Most common melanoma (75%)
What is lentigo maligna melanoma?
Malignant cells that are superficial, found usually in elderly patients on the head or neck.
Called Hutchinson’s freckled if noninvasive.
Least aggressive type, very good prognosis.
What is acral lentiginous melanoma?
Occurs on the palms, soles, subungual areas, and mucous membranes
What is nodular melanoma?
Vertical growth predominates, lesions are usually dark.
Most aggressive type, worst prognosis.
What is amelanotic melanoma?
Melanoma from melanocytes but with obvious lack of pigment
What is the most common type of melanoma?
Superficial spreading
What type of melanoma arises in Hutchinson’s freckle?
Lentigo maligna melanoma
What is Hutchinson’s freckle?
Lentigo maligna melanoma in the radial growth phase without vertical extension.
Usually occurs on the faces of elderly women.
What is stage IA melanoma?
What is stage IB melanoma?
What is stage IIA melanoma?
1-2 mm with ulceration or 2-4 mm without ulceration
What is stage IIB melanoma?
2-4 mm with ulceration or > 4 mm without ulceration
What is stage IIC melanoma?
> 4 mm with ulceration
What is stage III melanoma?
Positive nodes
What is stage IV melanoma?
Distant metastases
What are the common sites of melanoma metastasis?
Nodes, lung, liver, bone, heart, and brain
What are the metastatic routes of melanoma?
Both lymphatic and hematogenous
How is the diagnosis of melanoma made?
Excisional biopsy or incisional biopsy for very large lesions
What is the role of shave biopsy in melanoma?
No role
What is the sentinel node biopsy?
Inject Lymphazurin blue dye, colloid with a radiolabel, or both around the melanoma.
The first lymph node in the draining chain is identified as the sentinel lymph node and reflects the metastatic status of the group of lymph nodes
When is elective lymph node dissection in melanoma recommended?
Controversial
What is the recommended size of the surgical margin for depth of invasion for melanoma in situ?
0.5-cm margin
What is the recommended size of the surgical margin for depth of invasion for melanoma
1-cm margin
What is the recommended size of the surgical margin for depth of invasion for melanoma 1-4 mm thick?
2-cm margin
What is the recommended size of the surgical margin for depth of invasion for melanoma > 4 mm thick?
3-cm margin
What is the treatment for digital melanoma?
Amputation
What is the treatment of palpable lymph node metastasis?
Lymphadenectomy
What factors determine the prognosis for melanoma?
Depth of invasion and metastasis are the most important factors
What is the workup to survey for metastasis in the patient with melanoma?
PE, LFTs, CXR
What is the treatment of intestinal metastasis of melanoma?
Surgical resection to prevent bleeding or obstruction
Which malignancy is most likely to metastasize to the bowel?
Melanoma
What is the surgical treatment of nodal metastasis in melanoma?
Lymphadenectomy
What is FDA-approved adjuvant therapy for melanoma?
Interferon alpha-2b (stages IIB/III)
What is the treatment of unresectable brain metastases in melanoma?
Radiation
What is the treatment of isolated adrenal metastasis in melanoma?
Surgical resection
What is the treatment of isolated lung metastasis in melanoma?
Surgical resection
What is the most common symptom of anal melanoma?
Bleeding
What is the treatment of anal melanoma?
APR or wide excision
What experimental therapy is available for metastatic disease in melanoma?
- Monoclonal antibodies
- Chemotherapy (e.g. decarbazine)
- Vaccinations
What is the median survival with distant metastasis of melanoma?
6 months
